Transcript

Damien Carrick: Hello, welcome to the Law Report, Damien Carrick with you. Today we ask; to what extent are we responsible for our own health?

Later, the case of a Sydney GP found liable for failing to refer a morbidly obese patient to an obesity specialist for lap band surgery.

But first, the extraordinary case of Natasha Harris. Last week a coroner in New Zealand found that her over-consumption of Coca-Cola contributed to her death.

Journalist: 30-year-old Natasha Harris drank up to ten litres of Coke every day, twice the recommended safe daily limit of caffeine. The Invercargill mother of eight died suddenly in February 2010. She was found slumped against a wall, gasping for air in her bathroom at home.

Damien Carrick: Boyd Swinburn is Professor of Population Nutrition and Global Health at Auckland University.

Boyd Swinburn: Well, Natasha Harris is rather a tragic figure who died recently in New Zealand and has had a coroner's report just come out in relation to her death. She was a 31-year-old. And what makes this case interesting was that the coroner put her death down to a cardiac arrhythmia, which is an abnormal rhythm of the heart leading to cardiac arrest. But he believed it was precipitated by her large intake of Coca-Cola. She would typically drink between six and ten litres of Coca-Cola a day, and he believed that the caffeine contained within that was sufficient to trigger an arrhythmia and her death.

Damien Carrick: Her health and her lifestyle profile were a complicated one, though, weren't they. She also smoked something like 30 cigarettes a day.

Boyd Swinburn: She did indeed, and she had a very poor diet as well, and so she obviously had a lot of other things going on in her life. And I guess by the Coca-Cola and smoking you would say she was rather an addictive person or was rather addicted to these substances, but nevertheless on the coroner's finding, despite the fact she smoked 30 cigarettes a day, there wasn't anything within her lung pathology that suggested that was a cause, although obviously those cigarettes can be irritating to the heart as well as the caffeine in the Coke.

Damien Carrick: So she smoked 30 cigarettes a day, she didn't drink alcohol, she was a stay-at-home mum looking after eight children, and it was reported that she didn't eat very much, she often skipped breakfast, often skipped dinner, and her teeth were so rotten that they had to be extracted. Presumably that was as a result of the sugar.

Boyd Swinburn: Absolutely. Well, the sugar and the acid…soft drinks are very high in acid as well which eats away at the enamel, and it's reported in the coroner's report that one or more of her children were born without enamel on their teeth, presumably as a result of her intake of Coca-Cola. So she certainly had a lot of manifestations of an unhealthy lifestyle. But I think the important thing is that the coroner did single out Coca-Cola as the likely cause of the arrhythmia. I mean, she was only 31 and in general younger people can absorb large insults from their own personal lifestyle, it doesn't usually kill people at the age of 30, but this clearly did.

Damien Carrick: What happened if she didn't have enough Coke? What was the evidence?

Boyd Swinburn: I think she displayed…according to reports from friends and relatives, she displayed a lot of the signs and symptoms of somebody under withdrawal. She would get shaky and agitated and look for ways to release that agitation through getting some more Coke and drinking more Coke.

Damien Carrick: Here is Natasha Harris's husband, Chris Hodgkinson:

Chris Hodgkinson: We used to joke about that Coke would do harm to her, I suppose, but didn't realise that it actually would. She couldn't go without it. When she didn't have it she went through withdrawals as if she was on drugs.

Damien Carrick: There was an autopsy done after her death. What was the state of her liver?

Boyd Swinburn: Interestingly she was not a large person but her liver showed a fatty liver, a typical finding for large amounts of glucose ingestion, glucose and fructose ingestion which is from the sugar. So it showed an infiltration of fat into the liver tissue, and her liver was much larger than normal, and that's one of the recognised problems or complications from obesity, but also from large intake of sugary product.

Damien Carrick: And what is a safe level of caffeine and sugar consumption and what were her levels of caffeine and sugar consumption?

Boyd Swinburn: Well, per litre of Coca-Cola is about 100 mg of caffeine, and most medical reports or reviews in this area have suggested that up to 400 mg is safe in general, but for her case she would have been taking in more like 600 grams or 1,000 grams of caffeine, which is clearly way above what is recommended as a safe intake.

Journalist: In his finding, coroner David Crerar made a connection between her death and her Coke consumption.

Reading, coroner's report: It is more likely than not that the drinking of very large quantities of Coke was a substantial factor that contributed to the development of metabolic imbalances which gave rise to the arrhythmia.

Damien Carrick: Ten litres of Coca-Cola a day, 30 cigarettes a day, a very poor diet, the stress of raising eight kids; how does a coroner apportion or separate out responsibility for each of these factors?

Boyd Swinburn: Well, I think it's a tough job that they have to do, particularly when the cause of death like an arrhythmia leaves only quite small fingerprints for the pathologist to determine, and so the assumption is that it's arrhythmia, but there seems to be general agreement that that was the case. And the attribution of the various factors is a tough call, and the coroner has to make a judgement based on the balance of probabilities. Coca-Cola were represented by a pathologist who pointed out a whole lot of other potential contributors and the coroner took that into account but came down on the balance of probabilities that it was the large quantities of Coke that she was taking in that caused these metabolic disturbances.

Damien Carrick: And do you know, is this the first time that a coroner has made this kind of finding?

Boyd Swinburn: Well, it's the first time to my knowledge, and he doesn't refer to any other cases like that, so I'm issuing that this is the first time.

Damien Carrick: The coroner goes on to make some very interesting recommendations. What does he recommend?

Boyd Swinburn: He does make interesting recommendations and they are on the basis of the requirements for labelling and warnings on drinks, and he notes that drinks like Coca-Cola and other beverages containing caffeine don't have to be labelled with a specific warning around caffeine but that high caffeine drinks like Red Bull and V and other drinks with much higher doses of caffeine come under a separate regulation and they do need to state that this is a high caffeine drink and therefore give I guess the consumers more warning that there might be a problem. So these energy drinks come under a different regulation standard to Coca-Cola, and he's suggesting that the Ministry of Health look at the regulation and whether drinks like Coca-Cola shouldn't come under this more stringent type of regulation.

Damien Carrick: And they should contain the sugar levels, the caffeine levels, and a warning on the dangers of over-consumption?

Boyd Swinburn: Yes, that it must be labelled with the amount of caffeine, along with an advisory statement that the food contains caffeine and is not recommended for children, pregnant or lactating women, and individuals sensitive to caffeine. And it is interesting, this advisory statement, this idea that caffeine is not recommended for children I think needs to be explored a bit more as well. You know, young children who drink Coca-Cola will be getting a high dose of caffeine, and caffeine is a stimulant, it's mildly addictive, and obviously for children who have small body sizes it will have an enhanced effect. And so I do think we need to look at the role of these kinds of caffeinated drinks for children and whether there shouldn't be an advisory statement around these drinks that they are not recommended for children.

Damien Carrick: So I'm assuming that you actually support this recommendation?

Boyd Swinburn: I think in our society the private sector supplies the food and consumers make the choice. Consumers need all the information that they can have to make the right choice, and the evidence provided by the family in this case were that they didn't consider that Coke was a bad or potentially lethal product because it wasn't labelled as such, and they compared that with the cigarettes that she was smoking where there are clearly label warnings and she did clearly understand the health risks that she was undertaking.

Now from New Zealand to New York where soft drink giant Coca-Cola is also defending itself in court. New York Mayor Bloomberg has a track record of innovative public health initiatives. He has banned trans-fats, ordered chain restaurants to post calories on their menus, and has restricted smoking in public places. Last year Mayor Bloomberg announced a new municipal law that would restrict the size of soft drink cups to half a litre. It's a measure designed to tackle the obesity epidemic, a plague that strikes African Americans and Hispanics in disproportionately high numbers. Here's Mayor Bloomberg:

Michael Bloomberg: We're not taking away anybody's right to do anything, all we're trying to do is to remind you that this is something that is detrimental to your health and to do something about this national epidemic.

Damien Carrick: These new cup restrictions are due to take effect in March, but the soft drink industry is challenging the law in court. In a fascinating twist, one of the USA's oldest civil rights groups, the NAACP, the National Association for the Advancement of Coloured People, has joined the challenge. The NAACP point out that municipal bylaws don't apply to supermarkets and chain convenience stores like 7-Eleven, and this means the new restrictions will adversely affect independent local corner stores which are more likely to be owned by minorities.

Journalist: The New York chapter of the NAACP is backing a lawsuit filed to try and stop the city. Hazel Dukes is the New York chapter president:

Hazel Dukes: It's not about race, it's about economic prosperity and how the small business is being punished while we allow the big corporate people again to have their own way.

Damien Carrick: Coca-Cola has for many years supported the NAACP, but the organisation says this had no bearing on its decision to support the challenge. Boyd Swinburn says it is important to understand the connections between lobby groups and corporations and to carefully assess the evidence supporting the idea that minority owned businesses might suffer.

Boyd Swinburn: That does need to be proven, and I think there's a lot of studies now coming out showing that if you change the nature of what is in these corner stores, so it's not just full of confectionery and soft drink and you have more groceries and other regular items that people want, that actually the bottom-line doesn't suffer. So I think those types of statements need evidence behind them before you take them at face value.